This research addresses two major issues, first is the methodological problems involved in measuring compliance and second is the behavioral problems involved ipredicting and improving compliance in an indigent miultiethnic population. We intend to use both direct and indirect measures of hematologic malignancy patient adherence to prescribe self-medication requirements. Direct measures include identification of two drugs (allopurinol and prednisone) in plasma samples. Indirect measures include self reports, therapeutic effect leukocyte (granulocyte) levels, platelet levels, and uric acid levels. We are particularly interested in identifying direction (over versus under-compliance), degree, pattern, regularity, and treands (maintenance over time) in compliance. Measures of compliance with clinic appointments (usually for infused chemotherapy) and self referral (appropriateness and delay) in response to warning symptoms will also be collected. Predictors of noncompliance will be considered to five classes: cultural factors, social factors, psychological factors, environmental factors, and therapeutic factors. We intend to use repreated patient interviews and medical record reviews to acquire these data. Several standardized psychological and social adjustment scales will be integrated into the patient interviews. We will introduce three intervention packages to staggered cohorts of patients to test the effect upon compliance. The first package (Patient Education Core) consists of providing audiovisual descriptions of the disease and side effects combined with staff counseling, providing tools to help the patient use the health care delivery system, mailing postcard reminders, and providing a dishcarge poster. The second package consists of nurse home-visits to help the patient increase his level of compliance by p;hysically structuring his home environment and by increasing social supports. The third package consists of shaping self-medication behavior through a progressive behavior acquisition and reinforcement approach. The design presented allows us to test the independent and the combined effect of each of these interventions. We will use a modified interrupted time series design with baseline controls. Six staggered cohorts (2 control and 4 intervention) of patients will be phased into and out of the study allowing us to follow each patient for six months.